tbuckley/cabot-search huggingface dataset:
Analysis of incidence/mortality/cost for thrombotic events in hospitalized patients with lung cancer using the National Inpatient Sample database.
Authors: Kuldeepsinh Atodaria, Christian Fidler
Journal: Journal of Clinical Oncology (2022)

12073 Background: Thrombotic events are a common complication of lung cancer. We performed a retrospective analysis of an inpatient adult population (age ≥18) using the National Inpatient Sample (NIS) database from the years 2003-2014. Methods: The analysis was performed on the NIS database, using IBM SPSS Statistics 28.0.0.0 software. The cases for lung cancer were selected based on ICD-9(International Classification of Disease) codes for lung cancer. The cases were weighted by Weight to discharges in the universe. These cases were checked for a diagnosis of acute lower extremity Deep Vein thrombosis (DVT) and acute Pulmonary Embolism (PE) again using ICD-9 codes. Chi square tests were utilized to check the significance of association between mortality and DVT/PE. Independent T-tests were utilized to check the association of cost of hospitalization and length of stay with DVT/PE. Results: There were a total of 4,940,262 cases (53.0% male) of lung cancer from the years 2003-2014. 112,569 (2.3%) cases had a diagnosis of acute lower extremity DVT, and 164,208 (3.3%) cases had a diagnosis of acute PE. Overall, death for lung cancer cases was 516,070(10.5%). Death rate in patients with DVT was 12.4%(frequency = 13,943). DVT and death during hospitalization were positively associated, X 2 (1, N = 4,936,702) = 578.792, p &lt;.001. Rate of death for PE was 15.5% (25,360). PE and death during hospitalization were positively associated as well, X 2 (1, N = 4,936,702) = 4540.012, p.000. DVT was associated with a prolonged length of stay ( M = 8.66 days, SD = 8.8.624), compared to cases without DVT ( M = 6.42 days, SD = 6.42), t(4,940,122) = 115.02, p =.000. DVT was also associated with increased total charges of hospitalization ( M = $ 62,950, SD = 85,105), compared to cases without DVT ( M = $ 41,764, SD = 55,410), t(4,864,517) = 124.09, p =.000. PE was associated with a prolonged length of stay ( M = 8.01 days, SD = 8.13), compared to cases without PE ( M = 6.42 days, SD = 6.41), t(4,940,122) = 97.89, p =.000. PE was also associated with increased total charges of hospitalization ( M = $ 56,161, SD = 76,585), compared to cases without PE ( M = $ 41,772, SD = 55,468), t(4,864,517) = 100.85, p =.000. Conclusions: DVT and PE are common complications of Lung Cancer. They are associated with increased mortality in these patients. DVT increases the mean LOS by 2.24 days, and mean charges by $21,186. PE increases the mean LOS by 1.59 days, and the mean charges by $14,389. Prevention of DVT and PE could help bring down the mortality, LOS and charges of hospitalization. This data provides support to the usage of prophylactic anticoagulation in patients with lung cancer as shown in recent trails with Direct Acting Oral Anticoagulants(DOACs), and further study of DVT/PE in Lung cancer patients would be warranted.
Globalization of oncology clinical trials: Which lower-middle and upper-middle income countries are participating?
Authors: Fidel Rubagumya, Wilma M. Hopman, Bishal Gyawali, Deborah Mukherji, Nazik Hammad, C.S. Pramesh, Ajay Aggarwal, Richard N. Sullivan, Christopher M. Booth
Journal: Journal of Clinical Oncology (2022)

e13512 Background: With globalization of cancer research, many randomized controlled trials (RCTs) led by high income countries (HICs) are now enrolling patients from lower- and upper-middle income countries (LMICs/UMICs). While enrolling diverse global populations promotes research collaborations, there are unanswered questions about which countries participate in RCTs and how this may contribute to global research capacity. Here we describe which UMICs/LMICs participate in RCTs led by HICs. Methods: The study cohort was identified from a database of all oncology RCTs (systemic/surgery/RT) published globally during 2014-2017. The study cohort was restricted to RCTs led by HICs which enrolled participants from LMIC/UMICs. We used a bibliometric approach to explore whether the participation of UMICs/LMICs in RCTs led by HICs was as expected based on other measures of cancer research activity. Country-level bibliometric output for 2007-2017 was identified in the Web of Science database. We compared RCT participation (i.e. % of RCTs in our cohort that each LMIC/UMIC participated in) with country-level cancer research bibliometric output (i.e. % of total cancer research bibliometric output from the same group of countries that came from a specific LMIC/UMIC). Results: The global cohort included 694 RCTs; 636 (92%) of which were led by HICs. Among the HIC-led trials, 187 (29%) enrolled patients in LMICs (n=84) and/or UMICs (n=182); this formed the study cohort. The most common participating LMICs were India (50% of trials, 42/84), Ukraine (46%, 39/84), Philippines (25%, 21/84), and Egypt (14%, 12/84). The most common participating UMICs were Russian Federation (63% of trials, 115/182), Brazil (50%, 91/182), Romania (34%, 61/182), China (31%, 56/182), Mexico (31%,56/182) and South Africa (30%, 54/182). Several LMICs are over-represented in our cohort of RCTs based on proportional cancer research bibliometric output: Ukraine (46% of RCTs but 2% of cancer research bibliometric output), Philippines (25% RCTs, 1% output), Georgia (8% RCTs, 0.2% output). Several UMICs are also over-represented in the study cohort of RCTs including Russia (63% RCTs, 2% output), Romania (34% RCTs, 2% output), Mexico (31% RCTs, 2% output) and South Africa (30% RCTs, 1% output). The inverse relationship was seen for China (31% RCTs, 69% output). Conclusions: A substantial proportion of RCTs led by HICs enroll patients in LMICs/UMICs. The LMICs/UMICs which participate in these trials are not as one would expected based on overall cancer bibliometric output as a surrogate for research ecosystem maturity. Reasons for this apparent discordance and how these data may inform future capacity strengthening activities require further study.
Correlation between MSI, TMB, and RAS gene mutation in solid tumors.
Authors: Qingchang Li, Zhengying Bian, Juan Ma, Guanghua Lu, Siqi Chen, Ran Ding, Fanfeng Bu
Journal: Journal of Clinical Oncology (2022)

2624 Background: RAS gene family encodes a protein that is a member of the small GTPase super family and plays an important role in the regulation of cell proliferation and promoting oncogenic events. Studies have reported that RAS gene shows a high mutation frequency in lung cancer, colorectal cancer and pancreatic cancer. However, the relation between RAS-mutant and RAS-wild type tumors in tumor mutation burden (TMB) and microsatellite instability (MSI) remain unclear in pan-cancer. Methods: We retrospectively analyzed 15188 Chinese patients with pan-cancer from laboratory of Simcere Diagnosis (Nanjing, China) during 2019-2021. Somatic mutations in tumor samples were assessed by next-generation sequencing (NGS). We evaluated RAS (KRAS, NRAS and HRAS) mutation frequency, TMB and MSI in RAS-mutant and RAS wild-type tumors. Results: RAS mutations were detected in 2663 (17.5%) samples, including 88.7% of KRAS mutations, 9.1% of NRAS mutations and 3.5% of HRAS mutations. The top 6 frequently cancers were colorectal cancer (829, 31.1%), lung cancer (747, 28.1%), pancreatic cancer (358, 13.4%), biliary tract cancer (210, 7.9%), liver cancer (78, 2.9%), and gastric cancer (73, 2.7%). We found that the incidence of MSI-H in patients with RAS-mutant solid tumors was 3.3% and the frequency of MSI-H was significantly higher in RAS-mutant gastric cancer than that in RAS wild-type (RAS-MUT vs RAS-WT, 20.5% vs 3.5%, p &lt; 0.001). Contrary to our assumption, it was not observed in colorectal cancer (RAS-MUT vs RAS-WT, 5.8% vs 6.9%). In the analysis of TMB, RAS gene mutation was associated with higher TMB (P &lt; 0.01). 27.4% of RAS-mutant gastric cancer and 10.8% RAS wild-type gastric cancer were classified as TMB-H (TMB ≥10 muts/Mb) (P＜0.01), while 13.4% of RAS-mutant colorectal cancer was TMB-H, with no significant difference between RAS wild-type. However, we did not observe a close association between MSI, TMB and RAS gene mutations in lung cancer, pancreatic cancer, biliary tract cancer, and liver cancer. Conclusions: We analyzed RAS gene mutations in Chinese patients with solid tumor. Our data showed that RAS mutations were associated with TMB-H and MSI-H in solid tumors, especially gastric cancer. In colorectal cancer, RAS mutations were associated with higher TMB, but not TMB-H. It was showed that RAS mutations in specific cancer types, such as gastric cancer and colorectal cancer, may be related to the efficacy of immunotherapy.
Regorafenib combined with PD-1 monoclonal antibody in the second-line setting for hepatocellular carcinoma (HCC): A retrospective, real-world study in China.
Authors: Zhongchao Li, Lei Li, Jingtao Zhong, Kai Cui, Chengsheng Zhang, Xuetao Shi, Pengfei Sun
Journal: Journal of Clinical Oncology (2022)

e16145 Background: In China, the first-line TKI therapy for advanced HCC is a common standard treatment modality. Meanwhile regorafenib combined with anti-PD-1 antibodies (PD-1) exerted promising effects on unresectable hepatocellular carcinoma (uHCC). Still，more clinical evidence is needed to optimize second-line treatment for uHCC. In this single-center, retrospective real-world study, we look forward to further clinical benefits of regorafenib combined with PD-1 monoclonal antibody as second-line treatment of uHCC in China. Methods: We reviewed the medical data of 55 patients with HCC and received regorafenib combined with PD-1 monoclonal antibody for second-line treatment from April 2019 to April 2021. Patients were treated with regorafenib combined with PD-1 monoclonal antibody for at least 1 cycle (21days). The progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) were observed. Results: The median age was 52 years (range 29-72), 89.1% were male, 78.2% patients had hepatitis B. At study entry, the proportions of patients with Child–Pugh A/B class were 61.8%/36.4% (unknown: 1.8%); the proportions of patients with ECOG performance status 0/1/2 were 70.9%/21.8%/7.3%; the proportions of patients with BCLC stage A/B/C class were 5.5%/9.1%/83.6% (unknown: 1.8%); For prior targeted therapy, the proportion of patients with sorafenib/ lenvatinib / apatinib were 85.5%/9.1%/1.8% (unknown:1.8%), 1patient did not receive targeted therapy. Regorafenib combined with PD-1 monoclonal antibody was used for second-line systemic therapy, the PD-1s used mainly were sintilimab (n = 23), camrelizumab (n = 21), tislelizumab (n = 10); The median initial daily dose was 120 mg (rang,40-160),and the proportions of patients with the initial daily regorafenib dose 160mg/120mg/80mg/40mg were30.9%/16.4%/43.6%/1.8% (unknown :7.3%). The median PFS was 7.9 month (95%CI:5.1, NA), ORR was 27.3%, DCR was 56.4%. Conclusions: The preliminary results of this retrospective real-world study, indicate that regorafenib combined with pd-1 therapy as second-line treatment provide clinical benefits in uHCC patients with a manageable toxicity in Chinese patients. Data will be further collected to reduce bias caused by small sample size and baseline differences.
Thromboprophylaxis in surgically treated colorectal cancer patients with tinzaparin: Intermediate results from the Onco-CAST trial.
Authors: V.N. Papadopoulos, E.I. Timotheadou, St. Aggelopoulos, N. Arkadopoulos, D. Manganas, Ch. Papavasileiou, V. Papaziogas, G. Tzovaras, D. Alexandrou, I. Baloyiannis, M. Flamourakis, I. Galanis, K. Perivoliotis, Manousos-Georgios Pramateftakis, Em. Bachlitzanakis, S. Koffas, A. Menni, M. Papadoliopoulou, P. Tzitzis, Antonios Michalopoulos
Journal: Journal of Clinical Oncology (2022)

e15611 Background: The incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) after colorectal surgery is approximately 29% and 1.6% respectively. The incidence of asymptomatic postoperative DVT in colorectal cancer (CRC) patients has been reported as high as 20%, even under thromboprophylaxis. Thus, thromboprophylaxis after surgical treatment for CRC is crucial. Latest guidelines from International Initiative on Thrombosis and Cancer (ITAC 2019) recommend use of highest prophylactic dose of Low Molecular Weight Heparin (LMWH). Methods: Onco-CAST is a prospective, phase IV, observational, non-interventional cohort study evaluating a) current management approach for CRC surgical prophylaxis and b) efficacy and safety of tinzaparin at 8.000 Anti-Xa IU, once daily (OD), for at least one month post hospital discharge. Patients enrolled after signing informed consent. Onco-CAST was conducted by the Hellenic Society of Coloproctology. Results: Results from 175 CRC patients from 9 Onco Surgical Clinics are reported. Participation completed 79% of patients at report time: 66% males, 67±12 years, BMI: 27.4±5.5. Histology: adenocarcinomas NOS 81%, mucinous adenocarcinomas 9%, small cell neuroendocrine carcinomas 2%, and others. High grade differentiation indicated: 26% and 5% metastatic. 32% treated with right hemicolectomy, 20% with low anterior resection, 12% with sigmoid colectomy, 9% with abdominal-perineal resection, 9% with left hemicolectomy and other methods. 67% treated open and 33% laparoscopic while the median number of lymph nodes dissected for left and right hemicolectomy was 32.5 (Q1-Q3:26-38) and 24 (Q1-Q3: 14.5-32), p = 0.0253. Factors related to thrombosis risk are presented in table, notably, 95% of patients accumulated ≥3 risk factors. Median thromboprophylaxis duration with tinzaparin 8.000 Anti-Xa IU, OD, was: 37 days (1 st -3 rd quartile: 33-45 days). Three thrombotic events occurred (efficacy 98.3%, 95% CI: 95.1-99.4%), one DVT+PE, one DVT and one due to Central Venous Catheter (CVC). Eight patients experienced bleeding events (4.6%, 95%CI: 2.3-8.8%), 3 minor, 3 major and 2 CNMB, 2 had a possible relation to thromboprophylaxis (1.1%, 95%CI: 0.3-4.1%). Conclusions: Thromboprophylaxis in Surgically Treated Colorectal Cancer Patients with Tinzaparin intermediate dose seems safe and efficient approach.[Table: see text]
Comparing online engagement and academic impact of lung cancer research: An altmetric attention score and PlumX analysis.
Authors: Arun Muthiah, Chandrasekar Muthiah, Chapman Wei, Hina Khan
Journal: Journal of Clinical Oncology (2022)

11044 Background: Social media has proven vital in the rapid dissemination of literature to medical professionals and the public. In recent years, seminal research articles have yielded breakthrough therapies for lung cancer, including targeted drugs and unique immunotherapy-based combinations. New metrics such as the Altmetric Attention score (AAS) and PlumX Impact score capture interactions through social media and other public forums and serve as swifter counterparts to citations, which can take years to accrue. In this study, we characterize and compare AAS, PlumX and traditional bibliometrics (citation count, impact factor [IF]) of the top 100 trending articles on lung cancer. Methods: The 100 articles with the highest AAS featuring the keywords “lung cancer” between 01/2019 and 12/2021 were identified via Altmetric explorer. AAS, open access status, article type, topic, year and continent of publication were collected. PlumX and citation count were identified via Scopus database. Analysis included Spearman correlation coefficients and ANOVA. Results: A majority of the 100 articles were original investigations, of which 40% were RCTs, 22% retrospective cohort, 14% prospective, 9% basic science, 8% cross-sectional and 6% genome-wide association studies. Most articles focused on NSCLC (59%) and were conducted in North America (44%); 13% were in Europe, 36% multi-continental and the remainder &lt; 5% each. PlumX positively correlated with both citation count (p &lt;.001, r =.765) and IF (p &lt;.001, r =.581). AAS did not correlate with citation or IF. Articles on guidelines (p &lt;.001) and screening (p &lt;.001) were associated with higher AAS in comparison to other article types and topics, respectively. Basic science articles were associated with a higher PlumX (p &lt;.001) in comparison to others article topics. Year and continent of publication did not impact PlumX or AAS. Open access status did not correlate with PlumX or AAS. Conclusions: In our study, PlumX scores strongly correlated with citations and IF for recently published articles on lung cancer; this mirrors trends in other specialties. PlumX may be predictive in terms of academic impact, making it valuable to the research community. Though AAS did not correlate with traditional bibliometrics, its association with guidelines and screening articles suggests AAS may reflect interactions amongst a broader community (oncologic and non-oncologic clinicians). With the growing use of social media, the continued exploration of alternative metrics will play a role in understanding readership and fields of interest in lung cancer and in anticipating academic impact.[Table: see text]
Characteristics associated with functional resilience versus functional decline among adult patients with advanced non–small cell lung cancer.
Authors: Joy Tang, Sarah A. Janse, David Paul Carbone, Peter G. Shields, Melisa L. Wong, Nicole A Arrato, Barbara L. Andersen, Carolyn J Presley
Journal: Journal of Clinical Oncology (2022)

1538 Background: As more treatment options become available for advanced non-small cell lung cancer (NSCLC), oncologists still have difficulty predicting functional resiliency versus functional disability throughout treatment. Functional resiliency refers to the ability to recover baseline functional status in the face of an intervening health care event. This study aims to identify characteristics associated with resilience among adults with advanced NSCLC. Methods: In a prospective cohort of participants with newly diagnosed stage IV NSCLC, resilience was evaluated based on three functional disability items in the EQ-5D-5L (modified: mEQ-5D-5L) through 12 months of follow-up compared to baseline scores. This included patients treated with chemotherapy, immunotherapy, targeted agents and no treatment. Participants were classified into four groups: functional decline, maintenance, resilient, or variable. Resilience was determined based on improvement in disability scores, with a 1-point increase in functional status score representing a 0.5 standard deviation change on the mEQ-5D-5L. Patient characteristics included demographics, comorbidities, ECOG performance status, presence of brain or bone metastases, mood (GAD-7, PHQ-9), and lung cancer-specific symptoms (QLQ-LC13). Treatment toxicity and toxicity grades were also recorded. Differences between groups were determined through Fisher’s exact test or ANOVA. Results: Among 207 participants, 87 (42.0%) maintained functional status, 78 (37.7%) experienced functional decline, 22 (10.6%) were classified as resilient and 20 (9.7%) were variable. Characteristics associated with higher resilience (p &lt; 0.1) included being employed (p = 0.02) and living in a metro setting (p = 0.10). Characteristics not associated with resilience included age, education level, smoking status, presence of brain metastases, ECOG performance status, or psychological symptoms. Approximately half the participants (n = 105, 50.7%) who received treatment experienced toxicities. One third (33.8%) experienced ≥ grade 3 toxicities. There was no significant association between toxicity grade and resilience grouping. Conclusions: Characteristics associated with functional resilience included employment status and living setting. At least half of adults with advanced NSCLC experience treatment-related toxicities. It is important to determine characteristics of resilience to better understand which patients will tolerate cancer treatments.
Tumor marker testing among Medicare beneficiaries with cancer.
Authors: Christine Y. Lu, Robert Jin, Fang Zhang, Stephanie Argetsinger, Andrea N. Burnett-Hartman, Jing Hao, Stacey A. Honda, Christine Neslund-Dudas, Sheila Weinmann
Journal: Journal of Clinical Oncology (2022)

e13628 Background: Precision medicine has changed treatment practices for patients with cancer. Clinical guidelines recommend tumor marker testing for many types of cancer given its benefits. Studies have demonstrated that tumor marker testing increases use of appropriate targeted therapies which is associated with improved survival, particularly among patients with advanced or metastatic cancer. In March 2018, Medicare issued a national coverage determination (NCD) for next-generation sequencing to facilitate tumor marker testing. Methods: We conducted a retrospective study to assess tumor marker testing among Medicare beneficiaries with cancer from 03/01/2016 through 02/28/2020. Data were obtained from the Virtual Data Warehouses of 6 United States (US) healthcare systems in the Cancer Research Network, a well-established distributed data network for cancer research. Together these systems provide care to a diverse population of over 5.5 million people in the US. The index date was the first observed cancer diagnosis date recorded in the tumor registry during the study period. Subgroup analyses included those with lung, breast, colorectal, or prostate cancers, or those with advanced, metastatic or recurrent cancer. This is part of a larger project that aims to advance methods for scalable and rigorous evaluation of outcomes of coverage policies for genetic tests. Results: We report results from one health system (03/01/2016-3/31/2018) including Medicare beneficiaries ≥65 years and ≥ 90 enrollment days after the index date. Among 2,277 Medicare beneficiaries with cancer, mean (SD) age was 74 (6.8) years, 1,065 (46.8%) were women, 199 (9.9%) had a tumor marker test within 90 days of the index date, and 1072 (47.1%) started a cancer drug therapy within 90 days of the index date. Among Medicare beneficiaries with lung (n=352), breast (n=361) colorectal (n=135) and prostate (n=326) cancers, proportions of patients having tumor marker tests ranged from 2.2% to 12.8% within 90 days of the index date. Among 572 Medicare beneficiaries with advanced, metastatic or recurrent cancer, 59 (10.3%) had a tumor marker test within 90 days of the index date. Conclusions: The relatively low tumor marker testing rate among Medicare beneficiaries with cancer in this health system is consistent with the literature. Analyses are underway to examine changes in tumor marker testing among Medicare beneficiaries after the implementation of the 2018 Medicare NCD.